Identifying Children at Very Low Risk for Blunt Intra-Abdominal Injury in Whom CT of the Abdomen Can Be Avoided Safely

Christian J. Streck, Adam M. Vogel, Jingwen Zhang, Eunice Huang, Matthew T. Santore, Kuojen Tsao, Richard A. Falcone, Melvin S. Dassinger, Robert T. Russell, Martin L. Blakely, Patrick D. Mauldin, Bennett W. Calder, Kate B. Savoie, Jeffrey H. Haynes, Bindi J. Naik-Mathuria, Shawn D. St Peter, David P. Mooney, Chinwendu Onwubiko, Jeffrey S. Upperman

Research output: Contribution to journalArticle

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Abstract

Background Computed tomography is commonly used to rule out intra-abdominal injury (IAI) in children, despite associated cost and radiation exposure. Our purpose was to derive a prediction rule to identify children at very low risk for IAI after blunt abdominal trauma (BAT) for whom a CT scan of the abdomen would be unnecessary. Study Design We prospectively enrolled children younger than 16 years of age who presented after BAT at 14 Level I pediatric trauma centers during 1 year. We excluded patients who presented more than 6 hours after injury or underwent abdominal CT before transfer. We used binary recursive partitioning to derive a prediction rule identifying children at very low risk of IAI and IAI requiring acute intervention (IAI-I) using clinical information available in the trauma bay. Results We included 2,188 children with a median age of 8 years. There were 261 patients with IAI (11.9%) and 62 patients with IAI-I (2.8%). The prediction rule consisted of (in descending order of significance): aspartate aminotransferase >200 U/L, abnormal abdominal examination, abnormal chest x-ray, report of abdominal pain, and abnormal pancreatic enzymes. The rule had a negative predictive value of 99.4% for IAI and 100.0% for IAI-I in patients with none of the prediction rule variables present. The very-low-risk population consisted of 34% of the patients and 23% received a CT scan. Computed tomography frequency ranged from 4% to 96% by center. Conclusions A prediction rule using history and physical examination, chest x-ray, and laboratory evaluation at the time of presentation after BAT identifies children at very low risk for IAI for whom CT can be avoided.

Original languageEnglish (US)
Pages (from-to)449-458.e3
JournalJournal of the American College of Surgeons
Volume224
Issue number4
DOIs
StatePublished - Apr 1 2017

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Abdominal Injuries
Abdomen
Wounds and Injuries
Thorax
Tomography
X-Rays
Trauma Centers
Aspartate Aminotransferases
Abdominal Pain
Physical Examination
History
Pediatrics
Costs and Cost Analysis

All Science Journal Classification (ASJC) codes

  • Surgery

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Identifying Children at Very Low Risk for Blunt Intra-Abdominal Injury in Whom CT of the Abdomen Can Be Avoided Safely. / Streck, Christian J.; Vogel, Adam M.; Zhang, Jingwen; Huang, Eunice; Santore, Matthew T.; Tsao, Kuojen; Falcone, Richard A.; Dassinger, Melvin S.; Russell, Robert T.; Blakely, Martin L.; Mauldin, Patrick D.; Calder, Bennett W.; Savoie, Kate B.; Haynes, Jeffrey H.; Naik-Mathuria, Bindi J.; St Peter, Shawn D.; Mooney, David P.; Onwubiko, Chinwendu; Upperman, Jeffrey S.

In: Journal of the American College of Surgeons, Vol. 224, No. 4, 01.04.2017, p. 449-458.e3.

Research output: Contribution to journalArticle

Streck, CJ, Vogel, AM, Zhang, J, Huang, E, Santore, MT, Tsao, K, Falcone, RA, Dassinger, MS, Russell, RT, Blakely, ML, Mauldin, PD, Calder, BW, Savoie, KB, Haynes, JH, Naik-Mathuria, BJ, St Peter, SD, Mooney, DP, Onwubiko, C & Upperman, JS 2017, 'Identifying Children at Very Low Risk for Blunt Intra-Abdominal Injury in Whom CT of the Abdomen Can Be Avoided Safely', Journal of the American College of Surgeons, vol. 224, no. 4, pp. 449-458.e3. https://doi.org/10.1016/j.jamcollsurg.2016.12.041
Streck, Christian J. ; Vogel, Adam M. ; Zhang, Jingwen ; Huang, Eunice ; Santore, Matthew T. ; Tsao, Kuojen ; Falcone, Richard A. ; Dassinger, Melvin S. ; Russell, Robert T. ; Blakely, Martin L. ; Mauldin, Patrick D. ; Calder, Bennett W. ; Savoie, Kate B. ; Haynes, Jeffrey H. ; Naik-Mathuria, Bindi J. ; St Peter, Shawn D. ; Mooney, David P. ; Onwubiko, Chinwendu ; Upperman, Jeffrey S. / Identifying Children at Very Low Risk for Blunt Intra-Abdominal Injury in Whom CT of the Abdomen Can Be Avoided Safely. In: Journal of the American College of Surgeons. 2017 ; Vol. 224, No. 4. pp. 449-458.e3.
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abstract = "Background Computed tomography is commonly used to rule out intra-abdominal injury (IAI) in children, despite associated cost and radiation exposure. Our purpose was to derive a prediction rule to identify children at very low risk for IAI after blunt abdominal trauma (BAT) for whom a CT scan of the abdomen would be unnecessary. Study Design We prospectively enrolled children younger than 16 years of age who presented after BAT at 14 Level I pediatric trauma centers during 1 year. We excluded patients who presented more than 6 hours after injury or underwent abdominal CT before transfer. We used binary recursive partitioning to derive a prediction rule identifying children at very low risk of IAI and IAI requiring acute intervention (IAI-I) using clinical information available in the trauma bay. Results We included 2,188 children with a median age of 8 years. There were 261 patients with IAI (11.9{\%}) and 62 patients with IAI-I (2.8{\%}). The prediction rule consisted of (in descending order of significance): aspartate aminotransferase >200 U/L, abnormal abdominal examination, abnormal chest x-ray, report of abdominal pain, and abnormal pancreatic enzymes. The rule had a negative predictive value of 99.4{\%} for IAI and 100.0{\%} for IAI-I in patients with none of the prediction rule variables present. The very-low-risk population consisted of 34{\%} of the patients and 23{\%} received a CT scan. Computed tomography frequency ranged from 4{\%} to 96{\%} by center. Conclusions A prediction rule using history and physical examination, chest x-ray, and laboratory evaluation at the time of presentation after BAT identifies children at very low risk for IAI for whom CT can be avoided.",
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T1 - Identifying Children at Very Low Risk for Blunt Intra-Abdominal Injury in Whom CT of the Abdomen Can Be Avoided Safely

AU - Streck, Christian J.

AU - Vogel, Adam M.

AU - Zhang, Jingwen

AU - Huang, Eunice

AU - Santore, Matthew T.

AU - Tsao, Kuojen

AU - Falcone, Richard A.

AU - Dassinger, Melvin S.

AU - Russell, Robert T.

AU - Blakely, Martin L.

AU - Mauldin, Patrick D.

AU - Calder, Bennett W.

AU - Savoie, Kate B.

AU - Haynes, Jeffrey H.

AU - Naik-Mathuria, Bindi J.

AU - St Peter, Shawn D.

AU - Mooney, David P.

AU - Onwubiko, Chinwendu

AU - Upperman, Jeffrey S.

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Background Computed tomography is commonly used to rule out intra-abdominal injury (IAI) in children, despite associated cost and radiation exposure. Our purpose was to derive a prediction rule to identify children at very low risk for IAI after blunt abdominal trauma (BAT) for whom a CT scan of the abdomen would be unnecessary. Study Design We prospectively enrolled children younger than 16 years of age who presented after BAT at 14 Level I pediatric trauma centers during 1 year. We excluded patients who presented more than 6 hours after injury or underwent abdominal CT before transfer. We used binary recursive partitioning to derive a prediction rule identifying children at very low risk of IAI and IAI requiring acute intervention (IAI-I) using clinical information available in the trauma bay. Results We included 2,188 children with a median age of 8 years. There were 261 patients with IAI (11.9%) and 62 patients with IAI-I (2.8%). The prediction rule consisted of (in descending order of significance): aspartate aminotransferase >200 U/L, abnormal abdominal examination, abnormal chest x-ray, report of abdominal pain, and abnormal pancreatic enzymes. The rule had a negative predictive value of 99.4% for IAI and 100.0% for IAI-I in patients with none of the prediction rule variables present. The very-low-risk population consisted of 34% of the patients and 23% received a CT scan. Computed tomography frequency ranged from 4% to 96% by center. Conclusions A prediction rule using history and physical examination, chest x-ray, and laboratory evaluation at the time of presentation after BAT identifies children at very low risk for IAI for whom CT can be avoided.

AB - Background Computed tomography is commonly used to rule out intra-abdominal injury (IAI) in children, despite associated cost and radiation exposure. Our purpose was to derive a prediction rule to identify children at very low risk for IAI after blunt abdominal trauma (BAT) for whom a CT scan of the abdomen would be unnecessary. Study Design We prospectively enrolled children younger than 16 years of age who presented after BAT at 14 Level I pediatric trauma centers during 1 year. We excluded patients who presented more than 6 hours after injury or underwent abdominal CT before transfer. We used binary recursive partitioning to derive a prediction rule identifying children at very low risk of IAI and IAI requiring acute intervention (IAI-I) using clinical information available in the trauma bay. Results We included 2,188 children with a median age of 8 years. There were 261 patients with IAI (11.9%) and 62 patients with IAI-I (2.8%). The prediction rule consisted of (in descending order of significance): aspartate aminotransferase >200 U/L, abnormal abdominal examination, abnormal chest x-ray, report of abdominal pain, and abnormal pancreatic enzymes. The rule had a negative predictive value of 99.4% for IAI and 100.0% for IAI-I in patients with none of the prediction rule variables present. The very-low-risk population consisted of 34% of the patients and 23% received a CT scan. Computed tomography frequency ranged from 4% to 96% by center. Conclusions A prediction rule using history and physical examination, chest x-ray, and laboratory evaluation at the time of presentation after BAT identifies children at very low risk for IAI for whom CT can be avoided.

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